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Introduction
My eighth annual Chief’s Report for the Orthopaedic
Journal at Harvard Medical School will highlight a tremendous
year of growth and productivity in the Department. I will
spotlight the many significant contributions by the orthopaedic
staff at the Massachusetts General Hospital (MGH). I will showcase
our Department’s continued commitment to education,
research and clinical care and our Mission Statement, “to provide
the highest quality musculoskeletal patient care, teaching
and research, with a dedication to service and a commitment
to leadership.”
ANNOUNCEMENTS
YAWKEY CENTER FOR OUTPATIENT CARE (YCOC)
We have been in our new space at the Yawkey Center for
Outpatient Care (YCOC) for well over a year now. All agree that
our new state-of-the-art facility, adjacent to the main campus is
an unprecedented success! The YCOC has given us the opportunity
to double our clinical space and to practice as a cohesive
group in a centralized geographical location. In 2006, we will
see over 70,000 patients at the YCOC. Our patients are enjoying
the ease involved in using the facility which houses many
clinical programs at the MGH and has convenient underground
parking. Having centralized Radiology embedded in our second
and third floor suites has offered unparalleled efficiency and
greatly enhances the patient experience. I would invite everyone
to stop by our fabulous new clinical center.
From our offices in the YCOC we are watching construction
of a new hotel at the former Charles Street Jail site. The
hotel will have 308 rooms, and will feature a number of restaurants,
a health club and conference room space. This new
facility, which is tentatively scheduled to open in early 2007,
will add immensely to our patient and their family’s experience
when visiting the MGH.
HARRIS CONFERENCE ROOM DEDICATION
Three important new naming events occurred on
the Orthopaedic Service this year during the 35th Annual
Arthroplasty Course. We honored Dr. William H. Harris by:
1) renaming the Orthopaedic Biomechanics and Biomaterials
Laboratory (OBBL), the “Harris Orthopaedic Biomechanics and
Biomaterials Laboratory” (HOBBL), 2) naming the newly created
outcomes registry “The Harris Joint Registry”, 3) the rededication
of the recently renovated “Harris Conference Room” on
White 10. Over fifty participants including faculty members
from the Annual Advances in Arthroplasty Course attended
these events and were escorted through the MGH to visit these
3 important facilities… a facilities are a fitting tribute to a surgeon
who has dedicated so to the field of hip arthroplasty, the
MGH, and the Department of Orthopaedic Surgery! Dr. Harris
hosted all of the guests in the new “Harris Conference Room”
and was able to highlight the state-of-the-art audio and video
equipment that has been added. On display in the conference
room is a painting of Dr. Harris created by one of his former
patients as well as a large glass enclosure displaying a record of
his numerous contributions to the field of orthopaedic surgery.
This display includes Dr. Harris’ Kappa Delta Awards in 1970
and 1976, his 6 Hip Society Awards, diplomas, several important
patents and the letter establishing the Harris Professorship
at Harvard Medical School. The most prized items however, are
the reflections of the teaching (the room itself and photos of the
Fellows as examples), the clinical care (the portrait in scrubs as
an example), the innovations in surgical care (the crosslinked
polyethylene, the CDH implants, the modular metal backed
socket as examples) and contributions to the conquest of three
worldwide diseases, namely periprosthetic osteolysis, venous
thromboembolic disease, and the etiology of osteoarthritis.
We were all deeply moved by the ceremony and Dr. Harris
was greatly appreciative of this lasting tribute to him at the
MGH. Dr. Harris states, “The naming of the laboratories in my
honor is the climax of my 49 year career at the MGH, encompassing
both the clinical and research aspects of my endeavors
to advance orthopaedic science and patient care. Central to the
greatness of the MGH is the permeating and integral dedication
of both its people and the institution itself to that singular issue
– caring.”
AMBULATORY SURGICAL CENTER (ASC)
An exciting new addition to the Department opened in
2006. The “Orthopaedic Ambulatory Surgical Center” (ASC) in
the MG West Building in Waltham houses four outpatient operating
rooms, patient friendly pre- and post-operative care areas as well as large waiting rooms and other modern patient amenities.
The Medical Executive Committee of the ASC including:
Drs. Bertram Zarins, Jesse B. Jupiter, Jon “JP” Warner
(Chairman), Thomas J. Gill and Mr. David Gaynor is involved
in all aspects of developing and managing this new facility.
Mr. Gaynor reports, “The state-of-the-art ASC will provide a
friendly, safe and convenient environment for our patients and
families with amenities such as free covered parking, internet
access for waiting family members and a convenient location
right off the highway. On-time starts, short turnover time and
most importantly a consistent, talented teams in the operating
rooms will make the ASC a desired location for their surgical
cases.” These are lofty goals and we are committed to the
success of our new ASC. This new center represents a major
step forward for the MGH and creates a new paradigm for the
delivery of orthopaedic care.
Several new additions have been added to the faculty as
a result of our new center. The Ortho ASC is under the apt
direction of Medical Director, Jeffrey Wilson, MD. Dr. Wilson
is an Instructor in Anesthesia at the Harvard Medical School
and will be an active member of the Department and the ASC
Medical Executive Committee. Dr. Wilson received his B.A.
from Harvard College and his M.D. from Boston University
in 1982. He did his Internship in Internal Medicine at the
Boston V.A. Medical Center and was a Resident in Anesthesia
here at the MGH. He completed in a Fellowship in Anesthesia
at the Brigham and Women’s Hospital. Dr. Wilson comes to
us from the Caritas Good Samaritan Surgicenter in Stoughton,
where he was the Medical Director and Chief of Ambulatory
Anesthesia. Dr. Wilson has extensive experience in outpatient
and regional anesthesia, specifically targeted toward orthopaedics.
I wish him much success as the ASC continues to provide
optimum care for our ambulatory surgical patients.
Dr. Wilson says, “For the past 10 years I have dedicated
myself professionally to my clinical passion, regional anesthesia,
and to the development and maturation of an efficient,
respected surgery center which surgeons, patients and staff
love. I return to Mass General to pursue my dream job as medical
director of the new ASC with a fantastic staff. We will share
our enthusiasm and expertise in making our new surgicenter
meet and exceed your hopes and expectations.”
Please join me in welcoming Dr. Wilson and his family
to the MGH community: wife, Beth; and their children:
Melissa (21), who is going to be a Senior at the University of
New Hampshire; Rachel (18), who will be starting at George
Washington University and son, Jason (16), who is in high
school.
Also joining the Anesthesia staff at the ASC will be Dr.
Charles Kelly, an instructor in Anesthesia at the Harvard
Medical School. Dr. Kelly received his B.S. and M.D. from the
University of Massachusetts. He completed his internship and
residency training at Tufts New England Medical Center. He
has spent the last ten years working primarily at the Caritas
Good Samaritan Medical Center Surgicenter with Dr. Wilson.
“During that time Dr. Wilson and I worked closely and diligently together making the Surgicenter a profitable endeavor for the
Caritas medical system; an efficient and desirable workplace
for the surgeons; and an enjoyable experience for the patient
while maintaining the highest levels of quality, care and patient
safety. Over the past fifteen years my clinical interests have
evolved and working at the ASC will allow me a unique opportunity
to concentrate on my true passions regional anesthesia
and ambulatory orthopaedic surgery. I welcome this new challenge
and look forward to working with the excellent staff and
clinicians at the ASC.” Please join me in welcoming Dr. Kelly
and his family: wife, Mary, and children, Charles, (20) who is a
Junior at Roger Williams University; Patrick, (19) a Sophomore
at Saint Michael’s College, and Kathleen (13), a 7th grader in the
Cohasset Middle School, to the MGH.
Claire O’Brien, RN, CNOR, will be the nurse manager of
the center. Claire has over 7 years of nursing management
experience in the surgical setting and 24 years in the surgical
environment as a registered nurse. Claire holds a Bachelor of
Science in Nursing (BSN) from Salem State
College and a Masters in Business Administration (MBA)
from the University of Massachusetts. Claire will be responsible
for the management of the day-to-day operations of the
ASC including supervision of both clinical and administrative
staff. Claire reports, “We couldn’t be more excited about this
project. Dr. Wilson and I have been fortunate to recruit an
extraordinary staff with years of surgical experience between
them. We are all looking forward to the challenges and opportunities
that will be part of an ASC start up project. We all share
the Department of Orthopaedics passion for service excellence,
commitment to patient safety and desire for quality outcomes.
Opening a single specialty orthopaedic ASC provides us with an
opportunity to refine existing services and streamline clinical
practice and operations.” It is a pleasure to welcome Claire, her
husband, Kevin, and sons, Brendan (21), a senior at Hamilton
College in Clinton, NY and Collin (17), a senior at Stoneham
High School.
LUSTRUM REPORT AND DEPARTMENT RETREAT
I was most pleased to deliver a five-year, “Lustrum” Report
to the faculty at the May 10th Orthopaedic Staff Meeting. The
report to highlighted the group’s clinical and academic productivity
and set the stage for the Departmental/MGOA Retreat,
which was held in May over two days at the gorgeous Chatham
Bars Inn on the Cape. The Lustrum Report included an “MGH
Orthopaedic Timeline” where I remembered enduring contributions
that members of the department have made to the field
of orthopaedic surgery. In 2006, our Orthopaedic Department
celebrates its 108th year of existence! We are working to create
a display on the “Century of Orthopaedics at the MGH” for the
Yawkey Center and the hospital.
I was also very pleased to announce the appointment of
two new Vice Chairs in the Department: Dr. Andrew Freiberg
as the new Vice Chair of In-Patient Services and Dr. Jon J.P.
Warner as the new Vice Chair of Out-Patient Services. Both
of these individuals have been tremendous assets to the
Department and have brought their maturity, leadership and
innovation to our departmental activities. I welcome both of
them in their new roles and look forward to their future contributions
to our department. Dr. Freiberg reports, “It’s a great
honor to be appointed the first Vice Chair for Inpatient Services,
and I very much look forward to working with Dr. Rubash as
we strive to improve our quality and volume of care. There is
much optimism as we plan for our next five years, and we will
need to work hard to find ways to accommodate our incredible
growth.”
In addition, I highlighted the past five-years of growth in
the Department. We have increased our patient admissions
during this time, nearly 9%; our inpatient surgery nearly 10%
and our outpatient surgeries a staggering 19%. Each service
Chief and members of the service have contributed greatly to
our continued success in the Department. In addition, in 2005
we contributed over 197 publications and nearly 100 citations
at the ORS and AAOS Annual Meeting. The Department continues
its excellence in clinical activity as well as research and
scientific contributions
Orthopaedic demand over the next decade will grow
approximately 18% in all inpatient and outpatient services,
this is driven by our “baby boomer” wave, our technological
advances, and our patient expectations and their increasingly
active lifestyle. As a department we have to be prepared to
identify the future models for the delivery of orthopaedic care.
We must continue to be our patient’s best advocates and deal
with the many complex issues facing orthopaedic surgeons
which include: direct to consumer marketing, gain sharing,
specialty care centers including ambulatory surgicenters, as
well as opportunities to enhance our inpatient activities. These
and other important contemporary issues in orthopaedic surgery
formed a backdrop for the retreat at the Chatman Bars Inn.
The purpose of the Retreat was to begin a “strategic discussion
on the future of the Department.” The Retreat included four
major sections with an appropriate question to be answered
in each section. Section 1: Personalysis - How do we become
better communicators within the group, the department and
the Hospital? Section 2: Departmental Finances - How do we
leverage our resources to ensure continued financial success?
Section 3: Education - How do we better prepare our students,
residents and fellows for a future in medicine? Section 4:
Research - How do our research laboratories successfully participate
in thematic research? Over 30 physicians and scientists
attended The Retreat and the response was overwhelmingly
positive.
PRIMARY CARE ORTHOPAEDICS COURSE
The “Primary Care Orthopaedics” is a Harvard University
CME course run by the MGH Department of Orthopaedic
Surgery for the past 20 years. Current course director, David
Ring, and co-directors Richard De Asla, George Theodore, Tom
Gill, Malcolm Smith, and Kirk Wood have polished the course
content to deliver the fundamentals of musculoskeltal medicine
to over 130 primary care providers in two and a half days. The
course includes lectures, discussion groups, physical examinations
sessions and casting and splinting opportunities. As one
of the few courses of its kind, it continues to attract national,
and international participants in addition to its regional base.
NOAN CONGRESS
The National Association of Orthopaedic Nurses held its
26th Annual Congress in Boston in May. The mission of the
society is to advancing the art and science of orthopaedic care.
Many member of our Department prepared posters and gave
presentations at the Congress. Kathy Meyers, Nurse Manager
on White 6 had a poster entitled, “ Confronting Healthcare
Disparities Through Culturally Competent Care. Sharon
Brothers, RN, Operating Room Nurse for Orthopaedics, had
a poster titled, “ The Role of Orthopaedic Instrument and
Equipment Technician in the Operating Room. There were
also a number of interesting presentations. Janet Dorrwachter,
RN, and Dr. Andrew Freiberg presented, “A Spectrum of
Care for the Total Hip Arthroplasty- Three Different Surgical
Approaches.” Dr. John Siliski presented, Computer -Assisted
Surgery in Orthopaedics. Dr. Brian Grottkau presented,
“Current Trends in the Diagnosis and Management of Scoliosis.
Joanne Hughes Empoliti, Clinical Nurse Specialist and Ruth
Bryan, Perioperative Clinical Nurse Specialist presented, “Make
no Bones about it! Patient Safety is Important. Following
in the same vein, Dr. James Herndon presented, “Patient
Safety: What’s All the Fuss About?” Deirdrew Fleming, FNP,
Nurse Practitioner in the Sports Medicine Service presented,
“Making Sense of Shoulder Pain: Diagnosis and Management
of Common Shoulder Problems,” and Erin Hart, CPNP, Nurse
Practitioner with the Pediatric Orthopaedic Service presented,
“Another Day in the Pediatric Orthopaedic Clinic: Common
Diagnoses & Clinical Management.” Congratulations to NAON
and our many nurse presenters from the MGH.
NEW CLINICAL FACULTY
I am pleased to welcome Dempsey Springfield, MD, back
to the Department. Dr. Springfield obtained his undergraduate
degree from Emory University and his medical school education
at the University of Florida’s College of Medicine. He did
a residency in Orthopaedic Surgery at the University of Florida
and, after two years of military service, a fellowship in musculoskeletal
oncology at the University of Florida. He remained
on the faculty there until 1987 when he joined the Orthopaedic
Department at the MGH. He spent 9 years here before accepting
the Chair and the Leni & Peter W. May Professorship in the
Department of Orthopaedic Surgery at the Mount Sinai Medical
Center in New York City. Dr. Springfield is international known
for his work in musculoskeletal tumors. He is the co-editor of
the text, Surgery for Bone and Soft-Tissue Tumors published
in 1998, which is used by orthopaedic surgeons, residents, and
students around to world. “Dr. Springfield says he is delighted
to return to the Department of Orthopaedic Surgery and the
MGH after a ten year visit to New York City. He is excited to be
able to work with Drs. Hornicek and Raskin in the Orthopaedic
Oncology Division. The Connective Tissue Oncology Group at
MGH is a world renown group of sarcoma specialists and Dr.
Springfield feels honored to be included.” Dr. Springfield will
add immense depth and expertise to our department. Please
join me in welcoming, Dr. Springfield and his wife, Deanna,
back to Boston.
I would also like to welcome Peter Asnis, MD to the department
and the Sports Medicine Service. Dr. Asnis graduated
from Cornell University Medical College and completed his
Orthopaedic Residency at The Hospital for Special Surgery in
New York. Dr. Asnis recently completed a Fellowship with the
MGH Sports Medicine Service and performed in an exemplary
fashion. Dr. Zarins, reports, “Dr. Asnis will expand our capabilities
to treat hip and elbow problems using minimally invasive
techniques as well as the more traditional approaches to Sports
Medicine.” Now that he has completed his Sports Medicine
Fellowship he will be doing a mini-fellowship in hip arthroscopy
at the Hospital for Special Surgery in New York and the
Steadman Hawkins Clinic in Vail, Colorado. Dr. Asnis is interested
in the biomechanics of sports related injuries. Please join
me in welcoming Dr. Asnis, his wife, Brooke, and 3 children:
son, Owen, age 5, and 3-year-old twin girls, Caitlyn and Sydney
to the department and the MGH community.
The Foot and Ankle Service continues to grow at a
rapid pace and provides comprehensive care to patients from
the greater Boston area and beyond. Dr. Richard de Asla,
Co-Director of the Foot and Ankle Service, and his team on
research team on Jackson 12 had an outstanding year at
the Orthopaedic Research Society (ORS) and the American
Academy of Orthopaedic Surgeons (AAOS). It’s a pleasure
to congratulate Dr. de Asla for having received the OREF
Career Development Award this year at the AAOS. Dr. de Asla
explained, “The ultimate goal is to design a new and durable
total ankle replacement. The grant will fund research in how
ankle joint complex kinematics change with arthritis. This
information will be useful in prosthesis design.”
Guoan Li, PhD, reports, “Ankle biomechanics research
has been historically difficult due to the complicated anatomy
of the foot and ankle. Our newly developed imaging approach
provided us with the opportunity to directly observe the in-vivo
articulation of each joint of the ankle complex under normal
and pathological conditions”
These studies combine the use of robotic technology as
well as our dual fluoroscopic and MRI Imaging techniques to
develop an entirely look at ankle joint kinematics. Dr. de Ala,
Guoan Li, PhD, and their team are doing some outstanding
work and we welcome their continued input into the clinical
analysis of foot and ankle abnormalities. Congratulations
Rich!
Chaittanya “Chai” Mudgal, MD, is in his second year of
practice with the Hand and Upper Extremity Service and has
been an extremely active clinician. His microvascular surgery
training has added greatly to our expertise at the MGH and he
is rapidly incorporating himself into outstanding clinical as
well as research projects within the Hand and Upper Extremity
Service. Dr. Jupiter states, “Dr Mudgal has added to our Service
expertise in management of neuromuscular disorders as well as
becoming an important person in our ever expanding educational
programs.”
Timothy Bhattacharyya, MD, has been a welcome edition
to the Partners Trauma Service and has been splitting his time
between the MGH and the BWH. He has added to the clinical
as well as educational programs on the Trauma Service and
we are pleased that his practice continues to grow. In addition,
he continues to work as a site minder for CIMIT. Dr.
Bhattacharyya reports, “I continue to enjoy the rewards of
working in this challenging and collaborative environment. We
continue to grow our and increase our productivity. At home,
our son, Rohan, has begun walking and is getting very difficult
to keep up with!”
Kirk Wood, MD, Chief of the Orthopaedic Spine Service at
the MGH, continues to grow his clinical as well as academic
service. In addition to incorporating himself into the teaching
program at the MGH he has developed the new Boston Spine
Society. The inaugural event was held at the Copley Plaza Hotel
and featured John Hall, MD from Boston Children’s Hospital
as the guest speaker. In all, some thirty-five prominent spine
surgeons from around the greater Boston area attended. Dr.
Wood reports, “The Society brings together both Orthopaedic
as well as Neurosurgical spine surgeons to compare notes,
discuss cases and present new ideas in a relaxed and congenial
atmosphere. The society meets twice a year, and continues to
grow, even at this early stage.”
Henrik Malchau, MD, PhD, Co-Director of the Harris
Orthopaedic Biomaterials and Biomechanics Laboratory and
world-renowned researcher in the field of outcomes after total
hip and total knee arthroplasty continues to grow and expand
our outcomes expertise in the department. Recently, we have
added two new modules to the Yawkey Center for establishing
and validating the patient directed outcomes scores with those
obtained by physicians. This very important work will lay
the groundwork for development of a patient driven registry
program. Dr. Malchau states, “H-OBBL a web based software
for online capture of outcome measures has been further developed.
Through an IRB approved application clinical and radiographic
data is captured semi automatically; patient outcome
data is captured direct from a specific web application. The
Registry is currently implemented for the Reconstructive (hip
and knee replacements) and Shoulder services at MGH. Similar
outcome programs are planned for the Tumor, Hand, Spine and
Sport services at MGH. Statewide registries are developed and
will be functional during 2006 for Maine and Virginia.”
SERVICE UPDATES
ADULT RECONSTRUCTIVE (ARTHROPLASTY) SERVICE
The Arthroplasty Service, under the direction of Andrew
A. Freiberg, MD, has again had another outstanding year with
respect to both clinical activities and research. Our Morning
Arthroplasty Conference is recognized as one of the best
conferences in the MGH training program. In addition, multidisclipinary
CAOS (Combined Arthroplasty Oncology Service
Rounds) Conference has added greatly to our understanding
and capabilities in treating patients with Orthopaedic oncologic
problems.
The interest of both our clinicians as well as patients in
minimally invasive hip and knee arthroplasty continues to
grow. We perform a variety of types of minimally invasvie procedures
including total hip and knee arthroplasty, unicondylar
arthroplasty, and are developing a program for surface replacement.
In addition, we have futher refined our anesthetic and
peri-operative protocols and greatly enhanced our patients’
peri-operative pain and function.
The Arthroplasty Service had an outstanding presence
at this year’s AAOS and ORS Meetings with 39 podium presentations,
posters, and exhibits by our surgeons. We were
recognized for two outstanding awards: The Orthopaedic
Research and Education Foundation 2006 Clinical Research
Award for outstanding clinical research, presented to Dr. Harry
E. Rubash, Dr. Kevin Bozic (former Resident and HBS graduate),
Dr. Daniel Berry (former Harvard Orthopaedic Resident
and Chairman, Mayo), Dr. Michael Reis (UCSF), Dr. Patricia
Katz, Dr. Jonathan Showstack, and James Naessens, MPH. This
study entitled, “Using Clinical and Economic Outcome Data to
Influence Health Policy in the United States: The Case of Total
Joint Replacement,” was recognized for its multi-center perspective
on reimbursement for revision total hip arthroplasty.
The hypothesis and pilot work for this study was done at the
MGH and as a result CMS has modified their payment for revision
total hip as a result of this multi-center study. This is the
ORS/AAOS highest clinical research award. Congratulations to
Kevin and our team!
We also were honored with Best Poster Award: this award
is given to the presentation with the most impact in the field
of orthopedic surgery. The study entitled, “A Minimum 5-Year
Follow-Up of Highly Cross linked Polyethylene (HXLPE) Liners
in Total Hip Replacement,” Jeffery Geller, MD; Murali Jasty, MD;
Dennis Burke, MD; Harry E. Rubash, MD; Andrew A. Freiberg,
MD; William H. Harris, MD: Henirk Malchau, MD; Charles R.
Bragdon, BS; and Meredith E. Greene, BS, reviewed our 2-5
year follow up of the MGH polyethylene in total hip arthroplasty
thus us the first mid-term report of the new crosslinked polyethylene
that is functioning in-vivo as expected with minimal
wear.
Our Adult Reconstructive Fellowship Training Program
continues to be an outstanding one. This fellowship is one
of the oldest and most renowned in the field of Arthroplasty
and our fellows are drawn to our rich heritage of clinical and
research excellence. This year’s Fellows: Young Min Kwon, MD,
John Barrington, MD, Allen McDonald, III, MD and Carl Talmo,
MD have been an outstanding group of trainees. We will miss
them as they matriculate to a variety of programs across the
country. Dr. Kwon will join the academic faculty at Concord
Repatriation General Hospital, at the University of Sydney
in Australia; Dr. Barrington will join an outstanding practice
in Plano, Texas, the Texas Center for Joint Replacement, Dr.
McDonald will join a large private practice in Atlanta, Peachtree
Orthopaedic Clinic along with his Father; and Dr. Talmo will
work with an outstanding private practice group at the New
England Baptist Hospital.
Our research program in crosslinked polyethylene is thriving
in new applications in total knee arthroplasty, shoulder and
spine. This year we reported results of our initial clinical trials
evaluating wear utilizing these materials using radiosterometric
analysis (RSA). These new materials have outstanding wear
resistance and, as a result, have few of the liabilities of first
generation crosslinked polyethylenes. In addition, we recently
developed a constrained acetabular component that, for the
first time, allows an increased range of motion, the use of
crosslinked polyethylene and provides a powerful constraint
to prevent dislocation and now has early 1 -2 years follow-up
results with no failures.
We congratulate Dr. Guoan Li and his team for their outstanding
contributions at the Orthopaedic Research Society
(ORS) this year with reports on the Kinematics of Knee
Arthroplasty and Posterior Stabilized Knee Arthroplasty Post
Impingement Using Robotic Technologies, as well as his outstanding
ORS symposium
on Kinematics of the Knee. Here, he
reported some of his newest knee kinematics research as well
as unicondylar knee arthroplasty and high flexion knee data.
In addition, Dr. Li has developed
an extensive and innovative
dual fluoroscopy program to evaluate the clinical performance
of a variety of different knee arthroplasty designs with a highly
reproducible and accurate kinematic evaluation. Early results
are now available comparing different implant designs and
kinematics using these innovative methods.
Dr. Freiberg reports, “Our future plans include expanding
our clinical practices with an emphasis on state-of-the-art
methodologies for primary and revision arthroplasty. In addition,
we will have continuing emphasis on studying advances
in bearing surfaces and crosslinked polyethylenes. We will
continue with sustained efforts at long-term follow-up studies
using our Patient View Registry, which promises to guide
our clinical activities for many years to come. It is a pleasure
to be the Chief of such a fine Service with rich heritage and
an incredibly bright future.” In celebration of the generosity
of Richard and Ingrid Anderson, this year we initiated the
Anderson Arthroplasty Fund. This Fund will be used to support
a variety of functions for the Arthroplasty Service including
Fellowship training, additional research support, and educational
experiences for our faculty.
Dr. Freiberg and Dr. William H. Harris and the Arthroplasty
Service celebrated
the “46th Year End Party,” in June 2006, at
Dennis and Martha Burke’s home. The program was a spirited
event with cocktails,
dinner, and speakers including our graduating
fellows. We started the event with a group-racing event
at the F1 Boston racing track. It was an outstanding year-end
event and we look forward to many more in the future.
Preparations are currently underway for the 36th Annual
Harvard Arthroplasty Course. This year’s offering is entitled:
Advances in Arthroplasty: An emphasis on treatment option for
the young and will be held October 4 - October 7, 2005, at the
Hyatt Regency Hotel, in Cambridge. For more information, or
to obtain a registration form, contact Harvard Medical School,
Department of Continuing Medical Education at (617) 384-
8600 or e-mail: hms-cme@hms.harvard.
edu. Visit them on the
web at http://cme.med.harvard.edu/.
PODIATRY SERVICE
Under the direction of Dr. Robert J. Scardina, the M.G.H.
Podiatry Service remains committed to its mission to provide
excellence in both patient care and residency education &
training. The main campus practice has settled into our new
location along with other Orthopaedic specialties. We continue
to develop a stronger clinical and educational relationship with
the Foot & Ankle Service. A new laser scan cad/cam system for
fabrication of custom foot orthoses has been added to our clinical
practice. Associate staff members provide ambulatory care
at the three MGH Affiliated Health Centers (Revere, Chelsea and
Charlestown) and at non-affiliate health centers (South End
Community and Lynn Community), as well as in-patient consultation
services at Spaulding Rehabilitation Hospital. In 2005,
our group proudly celebrated 15 years of providing volunteer
foot care to patients at the Pine Street Inn.
The Council on Podiatric Medical Education conducted
a residency program site-visit at the MGH in December. The
program received provisional approval as a 36 month Podiatric
Medicine and Surgery Residency (PM&S-36), leading to Board
Qualification in Podiatric Surgery, Podiatric Orthopedics and
Podiatric Medicine for our current and future graduates. We
look forward to official approval in the spring of 2006. The
program now includes more than 20 non-podiatric medical
& surgical rotations integrated with longitudinal training in
podiatry. Of note, the MGH is one of only three hospitals listed
in the 2005 U.S. News and World Report ‘Best Hospitals Honor
Roll’ to sponsor a podiatric residency program, and the only one
with no podiatric medical school in its state.
As Service Chief and Program Director, Dr. Scardina maintains
a clinical and surgical patient care practice along with
seven other M.G.H. Podiatry staff members, and provides resident
surgical training with additional podiatric and orthopaedic
faculty members at M.G.H. and other Partners institutions.
“Together, our group members take pride in a twenty-plus
year history of service to the M.G.H. community and contributions
to podiatric post-graduate education. We eagerly look
forward to additional opportunities for growth and expansion
in all aspects of our Service under the auspices of the MGH
Orthopaedic Department”, notes Dr. Scardina.
FOOT AND ANKLE SERVICE
The Foot and Ankle service at MGH is under the leadership
of Co-directors, Drs. Richard de Asla and George Theodore. This
growing service continues to provide comprehensive clinical
care to patients in the MGH community and the greater Boston
area. During the past year the service has seen the addition of
a full time resident in the PGY 4 year. Dr. de Asla remarks, “ I
believe we provide a well balanced rotation with excellent operative
and clinic exposure. Dr. Heckman’s participation in the
office setting strengthens the rotation even further. The rotation
has been very well received.” The Foot and Ankle service
looks forward to new opportunities in the off-site ambulatory
surgery center as well as the vascular center.
In conjunction with the MGH biomechanics laboratory on
Jackson 12, Foot and Ankle enjoyed exceptional representation
at both the Orthopaedic Research Society and the American
Academy of Orthopaedic Surgeons meeting in March of 2006.
Two podium and two poster sessions were presented. The
week culminated in receipt by Dr. de Alsa of an “OREF Career
Development Award” dedicated to studying kinematics in the
arthritic ankle. The unique technique used for studying in vivo
kinematics as it applies to the ankle joint complex was also
presented at the CIMIT forum in Boston.
The service will soon focus on establishing a Foot and
Ankle Fellowship. Watch for more to come from this productive
academic service.
HAND AND UPPER EXTREMITY SERVICE
The Hand and Upper Extremity Service, led by Service
Chief, Jesse B. Jupiter, MD, the Hansjörg Wyss Professor of
Orthopaedic Surgery continues to be one of the busiest services
in the Department of Orthopaedic Surgery. Dr. Jupiter reports,
“The past 5 years have witnessed the Service become a comprehensive
hand and upper limb unit providing a wide breadth
of expertise in virtually every problem in the specialty. We
now have 4 full time faculty with each have unique and varied
expertise, our unit is a center of excellence for brachial plexus
problems, stroke, microvascular reconstruction and trauma
management, fractures and posttraumatic reconstructions of
the entire limb, pediatric trauma and reconstruction, and all
aspects of elective hand and upper limb surgery.”
Collaborations have continued with the Orthopaedic
Trauma Service and the Hand and Upper Extremity Service has
become an integral part of providing expertise in all upper limb
trauma as well as education and research activities. In addition,
the Service has become an internationally recognized center
for the management of traumatic and reconstructive problems
about the elbow and wrist. The Hand Service has integrated
Fellowship rotations with the Brigham and Woman’s Fellowship
making our Fellowship one of the most sought out Fellowships
in the country.
Due in part from a large ongoing research grant from the
AO Foundation as well as an association with the Amsterdam
Medical Center, we have developed an active clinical research
unit with 2 full-time research associates as well as PhD candidates
from Amsterdam. The qualities of research publications
and presentations reflect well on the unit itself and the
Orthopaedic Department.
The Annual Richard Smith Lectureship,
now in its 17th year, was another tremendous
success. Dr. Barry Simmons presented as the
as the Smith Orator. Each year this wonderful
program offers an opportunity for individuals
in the Boston Hand and Upper Extremity community
a forum to meet and present interesting
ideas and the newest innovative research.
THE HARVARD SHOULDER SERVICE
The Harvard Shoulder Service, led by Jon “J.P.” Warner,
MD, continues to grow and achieve excellence on three levels;
academic contributions, clinical service, and teaching initiatives.
The clinical volume has continued to grow with more
than 800 surgeries performed at the MGH by members of the
Shoulder Service. One area of recent development has been the
use of the newly developed Reverse Prosthesis to salvage failed
shoulder replacements and otherwise irreparable tendon tears.
Over 100 cases have been performed at the MGH with dramatic
improvement in pain and function for individuals who otherwise
had no alternative. The Shoulder Service has pioneered the
work in this area.
Educational initiatives also continue to grow. This year’s
fellows, selected from a national pool of 30, included our top
two choices. Our current fellows will be entering private practice
at the completion of their fellowship. Dr. Todd O’Brien has
gone into private practice on the North Shore and Dr. John
Costouros be returned to the Bay Area of San Francisco where
he has accepted a post as Chief of Shoulder and Elbow Surgery
at Kaiser Permanente of Northern California.
Our current fellows have also taken jobs. Dr. Ryan
Simovitch will go into private practice in Palm Beach Florida.
Dr. Scott Pennington will be joining a large orthopaedic private
group in Atlanta, GA. And Dr. Brett Sanders will be going on to
a fellowship in Hand Surgery in Edinburgh, England.
Dr. Peter Millett left our Service last summer to become a
member of the Steadman-Hawkins Clinic. He will be missed as
a surgeon, colleague and friend. We are proud to say that Dr.
Laurence D. Higgins has accepted a position on the Shoulder
Service and will have his primary responsibility as Chief of
the Sports Medicine and Shoulder Service at the BWH. He
will also be involved in patient care and research at the MGH.
Dr. Higgins was, for the past 10 years, Director of the Sports
Medicine and Shoulder Fellowship at Duke University.
The future of the Harvard Shoulder Service is an exciting
and bright one. Basic science projects, which promise to
yield important insights in to shoulder arthroplasty, include
an RSA analysis and 3-Dimensional Fluoroscopic Analysis. We
believe the information gained from this work may change the
understanding of shoulder reconstruction and ultimately lead
to greater durability of this surgery.
The Shoulder Service welcomes
Kelly Richards, NP, new nurse practitioner
in the service. She is heavily
involved in the clinical as well as the
research activities on the service. Dr.
Warner states, “Kelly Richards joined
the Shoulder Service as a welcome and
very needed addition. She will assist
with care of complex patients and
act as a coordinator for preoperative
and postoperative management of all
shoulder patients.”
Clinical research underway includes over 10 prospective
outcome studies of the effectiveness of surgical procedures on
the shoulder, and a patient-relational database which will allow
for internet-based acquisition of outcome information from
patients and their treating physicians.
Additionally, an initiative to develop a patient electronic
informed consent for different shoulder surgical procedures has
been started. This promises to improve patient education while
at the same time standardize the information given to patients
regarding the risks and benefits of surgery.
ORTHOPAEDIC ONCOLOGY SERVICE
The Orthopaedic Oncology Service led by the Service
Chief, Francis Hornicek, MD, PhD, continues to flourish. Dr.
Hornicek, attending, Kevin Raskin, MD, and Senior Consultant,
Henry Mankin, MD, were joined earlier this year by Demspey
Springfield. Dr. Hornicek states, “The Orthopaedic Oncology
Service, and the Center for Sarcoma and Connective Tissue
Oncology are extremely fortunate to have Dr. Springfield return
to Boston. Dr. Springfield has an excellent national and international
reputation in the field of orthopaedic oncology and as a
leader in orthopaedic surgery. His addition to our department
continues to strengthen this service, which was established
about 30 years ago.” Dr. Raskin continues to grow his practice
and Dr. Mankin is involved in clinical research projects. Dr.
Lawrence Weissbach will be leaving the Sarcoma Laboratory in
the fall and we wish him well. Dr. Christine Towle continues to
pursue cartilage research. Dr. Hornicek also reports, “the laboratories
are considering a new focus on stem cell research and
continue to expolore mechanisms of drug resistance in tumor
models. Together with Dr. Gebhardt and Dr. Anderson, we have
one of the largest musculoskeletal tumor fellowships. We are
pleased to continue are relationship with Boston Children’s
Hospital and BIDMC to build further on this strong foundation.”
The Oncology Group is truly impre4ssive and continues
to grow and prosper.
PEDIATRIC ORTHOPAEDIC SERVICE
The Pediatric Orthopaedic Service is in the midst of
expanding. The service has achieved capacity in terms of
outpatient volume. They are attempting to develop new care
models to meet the demands of their ever-expanding patient
base. The service continues to focus on establishing a solid
research program in regenerative medicine to complement the
ongoing clinical and basic science projects. They have enjoyed
increasing success in developing a national presence with 7 presentations
at national meetings. Additionally, they collectively
produced 5 orginal peer-reviewed publications, 4 review articles
and 1 book chapter. Drs. Albright, Grottkau and Kim continue
to labor tirelessly to provide outstanding pediatric orthopaedic
care to the patients of the MassGeneral Hospital for Children.
Dr. Grottkau states, “Our recent move to the Yawkey Center for
Outpatient Care has more than doubled our office space. We
now have a comfortable, adequate and engaging waiting area
for our patients and families. Our examination rooms, access
to radiology services, cast rooms and personal office space have
improved our abilities to provide timely, efficient, cost-effective
care to our young patients.”
Erin Hart, RN, MS, CPNP, continues to impress us with her
academic talents and this year was awarded the coveted “Nan
Hilt Journalism Award” for the outstanding paper of the year in
Orthopaedic Nursing for 2005. Her publication was on neonatal
foot disorders. She will be presenting and playing a large role
at the upcoming National Association of Orthopaedic Nurses
(NAON) conference in Boston.
SPORTS MEDICINE SERVICE
The MGH Sports Medicine Service has seen another year
of exponential growth, thanks to the leadership of Dr. Bertram
Zarins, Service Chief and Associate Director, Dr. Thomas
Gill. Most of the surgical procedures they perform are done
arthoscopically on an outpatient basis. When the MGH West
Surgicenter opens in July 2006 they will do most of their surgery
in the new center.
In September 2006 the
Service will move from its
current location on Yawkey
3200 to a new MGH Sports
Medicine Center. This 16,000
square foot facitily will be
located at 175 Cambridge
Street, next to the Holiday
Inn and close to the hospital.
This new space will allow the
physicians in the service to
expand their ability to provide
first class care to our patients.
The orthopaedic surgeons, primary care physician, and physiotherapists
in the Center will have a close working relation.
There will be space for clinical research and education. The
new center will also have an in-house Sports Medicine Physical
Therapy Unit. This new facility will add immensely to the luster
of this world-class service.
Dr. Tom Gill was recently named Medical Director for the
Boston Red Sox. In addition, MGH Sports Medicine Service
continues to provide care for the New England Patriots. The
quarter century mark on this alliance is quickly approaching.
Dr. Gill has stepped up to the role of Head Physician of the
Patriots and Dr. Zarins will be Medical Director for the team.
Members of the Service also have been team physicians for the
Boston Bruins for 30 years and for the New England Revolution
since the league was formed ten years ago.
Biomechanics research work continues with a focus on:
knee ligament reconstruction (anterior and posterior cruciate
ligaments), in-vivo shoulder kinematics and tissue engineering.
The tissue engineering research is involved in finding how to
repair meniscal and articular cartilage lesions.
The MGH Sports Medicine team is also pleased that Dr.
Peter Asnis will join the Service and the Department. Dr. Asnis
will specialize in minimally invasive (arthroscopic) hip and
elbow surgery.
ORTHOPAEDIC SPINE CENTER/ORTHOPAEDIC SPINE SERVICE
The Orthopedic Spine Center, at the MGH, under the
skillful Direction of Orthopedic Spine Service Chief, Kirkham
B. Wood, MD, is now in its seventh year. The Service continues
to be responsible for the clinical, teaching and research
activities related to cervical, thoracic and lumbar spine. The
members of this multidisciplinary Center include, Physiatrists,
Sayed Ali Mostoufi, MD, and James Sarni, MD, and collaborations
are expanding with Physiatry and the MGH Pain Center.
Physician Assistant, Lisa Byer (Orthopedic Spine), and John
James, RN, in the Access Program have contributed greatly to
the Service’s expansion. Nearly 8,000 outpatients are accommodated
annually. Dr. Wood notes, “Clinical and basic research
are an important part of Orthopedic Spine Center’s mission.
We have numerous clinical research investigations underway.
In addition, basic science research into the care, treatment and
understanding, of the spinal pathology has begun in conjunction
with the Orthopedic Research Laboratories, here, at the
Massachusetts General Hospital.”
It was a busy year for the Service whose members had
numerous articles published in Spine, Journal of Spinal
Disorders, and the Journal of Bone and Joint Surgery. Dr.
Wood is pleased to be Chairing the Scoliosis Research Society’s
Committee on Data Base and Co-Chairing the Scoliosis Research
Society’s Committee on Adult Spinal Deformity. This summer,
we will begin the second year of our Orthopedic Spine Surgery
Fellowship in conjunction with Drs. Fredrick Mansfield, Frank
Pedlow and Mitchell Harris (at the BWH). Along with Dr. Wood,
this team is the core of our academic Spine Service.
RESEARCH UPDATES
HARRIS ORTHOPAEDIC BIOMECHANICS AND BIOMATERIALS LABORATORY (HOBBL)
The Harris Orthopaedic Biomechanics and Biomaterials
Laboratory (HOBBL), led by Co-Directors Orhun Muratoglu,
PhD, and Henrik Malchau, MD, PhD, continues to play a significant
role in total joint arthroplasty research with many innovative
contributions. Members of the H-OBBL have contributed
in fields of cementing techniques, hip and knee implant design,
revision total hip arthroplasty techniques, biology of bone in
growth, load bearing surface applications in total joints (such
as the first and second generation highly crosslinked polyethylenes)
and also in the area of hydrogels for joint applications.
Currently, there are a number of clinical studies underway
at the HOBBL. One of these, in its fourth year, utilizes the
radiostereometric analysis (RSA) technique to determine the
wear behavior of a first generation highly crosslinked polyethylene
in conjunction with large head femoral components.
The data is already showing a marked reduction in the femoral
head penetration. In addition, another clinical follow-up study,
with a larger patient population in its sixth year, is showing
no detectible periprosthetic osteolysis. The H-OBBL is also
focusing on novel crosslinked polyethylenes with low wear
and high fatigue strength for applications in high-stress total
knee replacements. Under the direction of Dr. Muratoglu, the
team has added new inventions to their strong intellectual
property portfolio: two novel methods of improving the fatigue
resistance of highly crosslinked polyethylenes, the first uses
mechanical annealing and the second uses vitamin-E to stabilize
the residual free radicals and plasticize the base polymer.
Both of these technologies were licensed to implant manufacturers
and will be in clinical use within the next few years.
In addition, the laboratory is collaborating with Dr. Kirk
Wood to identify research focus areas in the spine. The team has
already identified a hydrogel technology for nucleoplasty of the
intervertabral disc; human cadaver studies are underway.
On an annual basis, the Laboratory brings in over $3 million
in funding from a variety of sources: government, foundations,
and industrial. The H-OBBL is over flowing with new activity
and energy. The skillful scientists in the lab had a phenomenal
year at the ORS/AAOS. Congratulations to the members of the
H-OBBL on these outstanding accomplishments!
BIOMATERIALS LABORATORY
This has been a busy year for the Biomaterials Lab guided
by Arun Shanbhag PhD, MBA. We published our first book “Joint
Replacements and Bone Resorption: Pathology, Biomaterials
and Clinical Practice,” edited by Arun Shanbhag, Harry Rubash
and Joshua Jacobs (Taylor and Francis, NY). It was satisfying to
see the 30 chapters authored by leading esearchers and clinicians
from around the world, collected in this form.
In the lab, we have continued to leverage the newest
technologies to gain insight into osteolysis around total joint
replacements. A combination of advanced gene chips representing
the entire repertoire of human genes, and targeted
multiplexed protein assays is driving our research to identify
markers for the onset of osteolysis. We have deepened our use
of core facilities and collaborators locally, and internationally. In
an era of rapidly shifting and maturing technologies, this stance
permits us to take advantage of each incremental development
without the accompanying capital investments. The skill sets
now represented in the lab are also evolving. We work with
individuals who can formulate research questions, plan experiments,
analyze data and communicate effectively.
Our previous research fellows: Dr. Koichiro Hayata, from
Tokyo Women’s Medical University Hospital, and Dr. Masayuki
Kawashima from Oita University (Japan) returned briefly to the
laboratory to complete the manuscripts detailing their studies.
Dr Mahito Kuwahara from Takagi
Hospital, Japan is continuing these investigations on
the biological mechanisms of osteolysis. Dr James (Hutch)
Huddleston, who did commendable work studying the kinetics
of macrophage interactions with cross-linked UHMWPE, is currently
on the faculty at Stanford University.
Dr Rajiv Sethi who started working in the laboratory as a
medical student, and continued as our Resident, will be graduating
from the program. We wish him too all the very best in
his future endeavors. We thank Dr. Lawrence Weissbach, of the
Molecular Sarcoma Laboratory who provided the much needed
molecular biology expertise and valuable friendship. And to so
many others who make life a little less difficult, everyday, a big
thank you.
BIOENGINEERING (ROBOTICS) LABORATORY
Guoan Li, PhD, Laboratory Director, and members of the
Bioengineering Laboratory, have continued using their dualorthogonal
fluoroscopic imaging technique for accurate measurement
of in-vivo musculoskeletal joint kinematics. The cutting
edge imaging technique and robotic testing, are being utilized
to provide baselines for the development of new concepts
in total knee arthroplasty, unicompartmental knee arthroplasty,
anterior and posterior cruciate ligament research, studies of the
in-vivo function of the lower and upper extremities, and human
spines. This research is aimed at developing new concepts in
the understanding of musculoskeletal joint functions, injury
mechanisms, and efficiency of surgical modalities.
Congratulations to Guoan Li, PhD and Thomas Gill, MD
for a newly awarded R21 research project from NIH which has
teamed up bioengineers and clinicians to explore the in-vivo
tension of anterior cruciate ligament. This research will fully
utilize the advanced dual-orthogonal fluoroscopic and MR
imaging techniques and the robotic testing system to quantify
the forces in human ACL during functional activiries, the first
of its kind to estimate in-vivo forces in human ligaments.
The laboratory recently celebrated the departure of Dr.Louis
DeFrate, who takes a faculty position at Duke Medical School
and will establish his own orthopaedic research laboratory. Dr.
DeFrate has been an integral member of the laboratory since
1999, and concentrated on the experimental and theoretical
modeling of the knee and soft tissue biomechanics. The laboratory
also celebrated Mr. Jeffrey Bingham’s Master’s Degree in
Department of Mechanical Engineering of MIT. Mr. Bingham
joined the laboratory in 2004, and has been developing a automated
global converging optimization method to accurately
matching the 3D models of the knee to the dual fluoroscopic
images, so that the in-vivo knee kinematics can be obtained. He
will continue his research in the laboratory working towards his
Ph.D degree of MIT. Jeremy Suggs, an MIT graduate student,
joined the laboratory in 2000 and is studying the mechanisms
that affect knee flexion after total knee arthroplasty. Mr. Lu Wu,
a graduate student of MIT, has been studying the in-vivo ankle
joint kinematics and in-vivo articular cartilage contact mechanics.
Mr. Daniel Massimini, an MIT graduate, has recently joined
the lab to conduct research on in-vivo human shoulder biomechanics
in collaboration with Dr. JP Warner. Ms. Meng Li,
a grauate of EE of Boston University joined our laboratory to
investigate the MR imaging process of human musculoskeletal
joints. Mr. Ali Hosseini, a graduate student of MIT, joined our
lab this year to investigate in-vivo ACL tension. Drs. Samuel
van de Velde and Kyung Wook Nha have joined us as postdoctoral
fellows in 2005 and both are actively working in-vivo
human knee joint biomechanics. Ramprasad Papannagari
and George Hanson, two young and core bioengineers, have
actively participated in a variety of clinical and robotic projects,
including in-vivo ACL, in-vivo TKA as well as in-vivo shoulder
investigations. The laboratory has recruited two more graduate
students to carry out research in upper extremity and spine.
The team had over 20 podium, posters and symposiums at this
year’s ORS and AAOS meetings and published extensively in
various orthopaedic and biomedical journals.
CARTILAGE BIOLOGY AND ORTHOPAEDIC ONCOLOGY LABORATORY
The Cartilage Biology and Orthopaedic Oncology
Laboratory is under the direction of Christine A. Towle, PhD,
and Dr. Henry J. Mankin. Dr. Towle’s research team is exploring
the mechanisms that regulate metabolism in normal
articular cartilage; aberrations in these mechanisms may lead
to cartilage damage in pathological conditions such as osteoarthritis.
In particular, the group is interested in understanding
the soluble and mechanical factors that regulate the integrity
of the articular cartilage in both health and disease. They are
beginning to dissect the roles that the various components of
static or invariant mechanical compression play in decreasing
extracellular matrix synthesis in articular cartilage. The laboratory
recently published a paper demonstrating that osmotic
stress, a component of static mechanical compression, acts
synergistically with interleukin-1 to stimulate the production
of COX-2 and prostaglandin E2. A grant from the National
Institute of Aging supports this investigation of the role of
IL-1 in mechanical signal transduction. In collaboration with
Tayyaba Hasan in the Wellman Center for Photomedicine, Dr.
Towle’s group is conducting preclinical studies in mice aimed
at developing a novel light-based technology as a minimally
invasive approach for protecting articular cartilage in conditions
such as osteoarthritis. The animal studies are supported
by a grant from CIMIT.
The Oncology group continues to focus on clinical, molecular,
and biochemical markers that may serve as predictors of
metastasis in bone and soft tissue tumors. Recent research
demonstrated that while COX-2 is not expressed in benign cartilage
tumors, it is expressed in about half of malignant chondrosarcomas.
The laboratories have access to a computerized
database with information on almost 17,000 patients treated by
the Orthopaedic Oncology Service including 1200 treated with
allograft transplantation. The data have been used in numerous
clinical studies.
Henry Jaffe MD and Crawford Campbell MD, bequeathed to
Dr. Mankin their pathology collections consisting of thousands
of cases, including histological slides, x-ray films, and patient
records. Dr. Mankin obtained a grant from the Orthopaedic
Research and Education Foundation (OREF) to convert this
incredible resource into a digital format for educational purposes.
The Musculoskeletal Tumor Society, corporate funding,
and donations from patients and their families further support
Dr. Mankin’s clinical research projects.
SARCOMA MOLECULAR BIOLOGY LABORATORY
The Sarcoma Molecular Biology Laboratory (SMBL),
under the direction of Francis J. Hornicek, MD, PhD, Chief
of Orthopaedic Oncology. This laboratory investigates novel
approaches to further advance the treatment of bone sarcomas.
The overall objectives of this laboratory are to explore
biological mechanisms of tumors arising in bone and perform
translational research into new treatment options for sarcoma
patients. Continued collaboration with Pharmaceutical companies
has provided the foundation for evaluation of new drug
development. Many of these drugs are derived from marine
sources and their corresponding biochemical structures quite
complex. The Sarcoma Molecular Biology Laboratory has published
articles pertaining to sarcoma biology, and has received
funding from a variety of sources including foundations, corporate
sponsors, and benefactors.
New areas of interest include stem cell research. Unlike
carcinomas, sarcomas do not have premalignant states, in
general. The mesencymal stem cells may give rise sarcomas
and may play an important role in the development of drug
resistance.
The Laboratory is sorry to announce the departure of Dr.
Lawrence Weissbach. Dr. Weissbach was a member of the of
the orthopaedic laboratories for over years and contributed
immensely to the laboratory and its success. We wish him well
into the future!
LABORATORY OF ORTHOPAEDIC BIOCHEMISTRY AND OSTEOARTHRITIS
Teresa Morales, PhD, directs the Laboratory of Orthopaedic
Biochemistry and Osteoarthritis Therapy. Dr. Morales has been
a member of many NIH panels, and continues to serve in
special emphasis panels. She explains, “The global mission of
the Laboratory is to understand the regulation of chondrocyte
biology in health and disease and to apply this knowledge
towards investigations of cartilage repair.” Dr. Morales and her
team continue to examine how normal regulatory pathways are
altered during osteoarthritis (OA) to cause progressive matrix
degradation, with major emphasis on the dysregulated actions
of the Insulin-like growth factor binding proteins (particularly
IGFBP-3). Work in this area was the subject of a podium presentation
at the International Congress of Osteoarthritis in
Boston, MA in December 2005 in collaboration with Dr. Ernst
Hunziker’s laboratory (Muller Institute, Bern Switzerland). Dr.
Adetola Adesida, formerly from the Tissue Engineering Centre
in Manchester, U.K., has recently joined the laboratory. Dr.
Adesida’s goals include the inhibition of synthesis of the IGFBP-
3 protein in human cartilage explants in order to study its
impact on cartilage pathophysiology. The group also continues
to make progress in understanding how to enhance chondrocyte
migration, a novel and potentially key area of investigation
in the cartilage repair field. Cell biology and proteomic
approaches are being used to advance knowledge in this area.
Dr. Morales and Dr. Hideaki Nagase from the Kennedy Institute
of Rheumatology (Imperial College London) are making headways
in discovering new protein regulators of motility.
The Laboratory’s funding includes an R01 grant from the
NIH. Congratulations to Dr. Morales for her noteworthy accomplishments!
LABORATORY FOR MUSCULOSKELETAL ENGINEERING
The Laboratory for Musculoskeletal Tissue Engineering,
under the direction of Mark Randolph and Dr. Thomas Gill,
focuses on cartilage repair and regeneration in the knee. Work
over the past two years, funded by the AO Foundation, continued
on tissue engineering strategies to repair lesions in the
avascular regions of the meniscus. Results presented at the
Orthopedic Research Society (ORS), in San Francisco, and the
International Cartilage Repair Society, in Ghent, Belgium, demonstrated
an efficient means to seed chondrocytes onto polygalactin
(PLGA) scaffolds, and the capacity of these cell-scaffold
constructs to heal bucket-handle lesions in swine meniscus.
A new collaborative agreement with the Genzyme Corporation
is exploring new scaffold materials and cell types for meniscal
repair and regeneration. Dr. Giuseppe Peretti, from San Raffaele
Hospital, in Milan, Italy, has been a long-time contributor to
this work and continues to collaborate on these studies. One of
their recent articles, “Cell-Based Therapy for Meniscal Repair:
A Large Animal Study,” was the winner of the 2005 Hughston
Award for the most outstanding paper in the American Journal
of Sports Medicine in 2004. This work was presented at the
American Orthopaedic Society for Sports Medicine’s meeting
in Keystone, Colorado in July.
Mark Randolph’s group continues to explore alternative
cell sources and new hydrogels for articular cartilage repair and
regeneration. Work published over the past year reports on the
cartilage-forming capability of chondrocytes from the ear and
the ribs. An additional study collaborating with Dr. Lawrence
Bonassar, from Cornell University, examined the ability of these
types of chondrocytes to integrate and heal cartilage disks
together, with increasing strength over time. Collaboration
with Dr. Kristi Anseth, at the University of Colorado, is exploring
photoactive substances that can form hydrogel scaffolds for
cartilage formation.
BIOMOTION LABORATORY
The Biomotion Laboratory, in Ruth Sleeper Hall, is directed
by David E. Krebs, DPT, PhD. Dr. Krebs explains, “The mission
of the MGH Biomotion Laboratory is to better understand the
biomechanical and neural constraints of human movement.
The major goals are to investigate the means by which, body
segment kinematics and kinetics are governed by neuropathic
and arthropathic conditions. Our objectives include determining
the means by which humans compensate for, and adapt to,
specific orthopaedic and neurophysiological motor deficits. We
employ state-of-the-art modeling, theory and data acquisition to
generate appropriately detailed analyses of impairments (organ
level function or dysfunction), functional limitations (whole
person function or dysfunction), as well as medical imaging
techniques such as MRI to quantify the internal derangement
of the joints and body segments. We recently acquired, and validated,
a wearable motion detection system that patients wear
continuously for up to a week. The device classifies over 50 different
activities (e.g., walking, climbing stairs) and records joint
motions, 32 times a second - even while sleeping!”
DEPARTMENT HOLIDAY PARTY
This year’s gala black-tie Department Holiday Party was
held at the Museum of Fine Arts (MFA), Boston. We had a
tremendous turnout and all had a wonderful time. The MFA
has one of the most comprehensive art museums in the world;
with a collection that encompasses nearly 450,000 works of
art. On was a special Exhibit, by great American landscape
photographer, Ansel Adams, which was touring the museum
at this time.
ANNUAL CHILDREN’S HOLIDAY PARTY
We held our sixth Annual Children’s Holiday Party at the
Boston Children’s Museum this past December and it was a
great day filled with laughter, fun and many little ones with
big smiles. After enjoying the sites in the museum, everyone’s
favorite, McDonalds, was served for lunch in a private function
room. After dessert, the kids were entertained by a clown and
visited by Santa and Mrs. Claus who passed out goody bags and
toys. Michelle Rose, from MGH Photography, was onsite and
captured wonderful family pictures which were distributed after
the event as a keepsake.
PERSONAL NOTE
2005 was another year of incredible growth and prosperity
in the Department of Orthopaedic Surgery at the MGH.
On May 12-13, we had our first Strategic Retreat for the Mass
General Orthopaedic Associates (MGOA) and the Department of
Orthopaedic Surgery. We established strategic goals and we will
now work to refine these goals over the ensuing year. A new
spirit of collaboration, cooperation, and department pervades
the Orthopaedic Service.
On June 3rd Kimberly and I celebrated the high school
graduation of our second child, Steven. Steven finished a wonderful
season in the 215lb weight class in wrestling and won
the sectionals and placed 3rd overall in the state. He is a gifted
athlete and we are hoping he utilizes these talents in his collegiate
career. He has not decided upon a college at this point
but plans to enter a business management program somewhere
in the East Coast. We hope that he will be able to leverage his
immense abilities in the future and we will miss him greatly as
he departs for college.
Kristen has just finished 10th grade and will embark upon
a summer of activities. She will be attending an outdoor program
where she can further develop her athletic and equestrian
activities. She has had a successful academic year, despite her
illness and is back to regularly attending class. Kim and I marvel
at her perseverance and resilience and hope and pray that
her health continues to improve.
Brad has just finished a successful freshman year at Rollins
College in Florida. He missed the NCAA cut in Swimming by
only a few 10th of a second and will continue to train through
the summer. He continues along his path towards a business
degree and later this year will get his scuba Dive Master
Certificate as he works on a ship in the British West Indies.
Brad and I are in the final phases of restoring a 1970 Chevelle
Super Sport. It is a beauty and we look forward to seeing its
completion.
Three teenagers make for an incredibly busy and complicated
household. Despite this, we have had an opportunity to
spend a little more time together as a family and to enjoy the
wonderful sites and activities of New England. After a hiatus
of approximately of fifteen years, Kimberly and I will travel
together to the International Hip Society later in the fall in
Paris. We look forward very much to this event and to our
thirtieth wedding anniversary.
Finally, I am so very proud of the many contributions of
our world-class orthopaedic department at the MGH. Our clinical
services and laboratories continue to grow and flourish and
we facing the challenges of our complex academic environment
with rigor and creativity. The opening of our new Ambulatory
Surgicenter in Waltham, the new Sports Medicine Center, on
Cambridge Street, and the continued recruitment of fabulous
junior faculty will form the foundation for Department of
Orthopaedic Surgery at the MGH in the future.
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